Is that rustling in the bushes a deer or is it my brother? What the hell. We’ll sort it out later… BANG! Most people would regard moral reasoning like this as potentially indicative of a deficit of ethical reflectiveness. Several paediatricians writing in the latest issue of Philosophy, Ethics, and Humanities in Medicine apparently agree. They have called for a moratorium on donating organs after cardiac death (DCD) until a number of troubling issues have been resolved. The pre-press, peer-reviewed article offers a good summary of the ethical issues.

“We have argued that DCD donors are not dead, and therefore that organ donation during DCD violates the dead donor rule.  Our concerns with DCD include the following: irreversibility of absent circulation has not occurred and the many attempts to claim it has all fail; conflicts of interest at all steps in the DCD process are simply unavoidable; premortem interventions to preserve organ utility are not justifiable; and consensus statements by respected medical groups do not change these arguments. 

“The truth, we believe, is that honesty requires that we face these problems instead of avoiding them.  Until the concerns we describe are seriously considered, full public disclosure occurs, and fully informed consent is obtained from donors, there should be a moratorium on the practice of DCD.  We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death.  These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent.  These are tall orders, and require open public debate.  Until this debate occurs, we call for a moratorium on the practice of DCD.”

Philosophy, Ethics, and Humanities in Medicine, Dec 29, 2011